Skin Donation Banks in India: All you need to know

Skin is the body’s primary protective barrier, and once it suffers burns, immediate coverage with skin substitutes becomes crucial to prevent vulnerability to infections and fluid loss due to the compromised protective function of the burnt skin.

You know about blood donation banks but are you familiar with donation of skin? Well, this is also a normal medical procedure where a layer of your skin is peeled off and donated to someone else in need such as burn victims or patients with severe skin injuries.

Understanding skin donation

Skin is the largest organ in the body. While skin donation might not be a widely known practice but like any other organ, it can also be donated and transplanted. Much like the life-saving potential of organ donation for individuals suffering from organ failure, skin donation offers a new lease of life to those with irreparable skin damage, like in cases of serious burns, where natural regeneration is not possible.

“In case of a smaller percentage of burns (lesser total body surface area burnt), skin from the un-burnt area of the patient is taken out and put on the burn wound to cover it,” said Dr Maneesh Singhal, Professor and Head of the Department of Plastic Surgery at All India Institute of Medical Sciences (AIIMS) in Delhi.

Dr Singhal added that a person can survive with less than 40 percent damage to the skin, but the loss of 40 percent to 50 percent of the skin may be fatal unless the damaged tissue is replaced.

“At this stage, the patient’s own skin is not available to cover the burn wound. In that scenario, we need some skin substitutes. It is said that skin is the best substitute for skin,” he explained.

The Ministry of Health and Family Welfare in its 2021-22 annual report, revealed that India witnesses around 7 million burn injuries annually, leading to an estimated 140,000 fatalities. Burns rank as the second largest category of injuries in India after road accidents.

The report emphasizes that “death and disability resulting from burn injuries can be largely prevented, given that prompt and proper treatment is administered by skilled healthcare professionals.” 

Skin is body’s primary protective barrier, and once it suffers burns, we become vulnerable to infections and fluid loss. So, it is crucial to immediately cover the affected area with skin substitutes, since the burnt skin can no longer provide protection.

The science of getting a skin graft

The skin has two main layers – the outer epidermis and the inner dermis. When removed, the retrieval team carefully takes only the epidermis and some dermis. Only 0.3mm thickness of the skin is harvested.

It is known that early grafting leads to lower rates of infection and subsequent complications. Autografts (a patient’s own skin) and allograft or homografts (skin taken from a deceased donor or cadavers, relatives and other human beings) are two common sources of grafts. 

Explaining the science behind skin donation, Dr. Singhal said that at a bank, the cadaveric skin is harvested from a donor’s body, packaged, and stored under optimal conditions.

“The bank provides the same stored skin to be reused as a graft in patients with severe burn injuries,” he said adding that the process is similar to a blood bank, where blood is donated and stored for future use in needy patients. “The skin bank is a valuable resource in providing allograft skin as a cover for partial or complete burn wounds effectively.”

In certain cases, a combination of meshed autograft and cadaveric allograft is used as a “sandwich” technique to cover the burnt area. This approach optimizes the available skin resources and promotes faster healing and regeneration of the patient’s own skin.

Dr Vijay Kumar, professor, and head of the Department of Plastic and Reconstructive Surgery at King George’s Medical University in Lucknow, said the skin donation process involves several stages.

“These include ensuring the donor cadaver is suitable for harvesting within 6 hours of death to screening, selection, and microbiological testing. Post-death, skin is harvested from hidden areas that are thighs, legs, and back,” Dr Kumar said. “Taking out skin does not cause any bleeding or disfigurement. The areas are bandaged once the skin has been harvested.”

Skin procurement is done using knives or dermatomes by authorized personnel. The harvested skin is placed in sealed sterile containers with normal saline and antibiotics, then refrigerated. It is then stored using various techniques such as cryopreservation, glycerol preservation, gamma-irradiation, or lyophilization, also called freeze-drying.

Skin is generally preserved in 85 percent glycerol solution and stored at a temperature between 4-5 degree Celsius for a period of up to 5 years. This provides more flexibility to surgeons who can use it for various burn cases.

Once applied, the cadaveric skin serves as a temporary dressing and is eventually rejected by the body over a four-week period. However, during this time, it offers several significant benefits:

• Effective control of protein and fluid loss from wounds
• Reversal of the hypermetabolic state, leading to improved nutritional status
• Control of wound infection and enhancement of the wound bed, preparing it for the acceptance of vital skin autografts
• Biological wound coverage until the autograft donor sites are ready for reharvesting, greatly minimizing protein loss, exudation, and pain

Who can be a donor?

Unlike kidney, liver, or bone marrow transplants, skin transplants do not require a blood or tissue match between the donor and recipient. Healthy skin from any individual can be used for anyone in need.

Individuals aged 18 and above are eligible to donate skin. Also, every person who donates eyes (in event of death) is eligible for skin donation. However, there is no obligation to donate skin if one chooses to donate their eyes.

Certain health conditions, such as AIDS, HIV, skin cancer, jaundice, hepatitis B and C, STDs, generalized infection and septicemia (pneumonia, tuberculosis, etc.), active skin infections, malignancy, or any evidence of skin cancer, preclude individuals from donating skin.

Dr. Kumar explained that for skin donation, the deceased person need be taken to a skin bank or any medical facility. Family members can simply contact the closest skin bank and the retrieval team will arrive at the place of death, whether it’s a home or a hospital.

The current state of skin donation banks in India

The huge gap in demand and supply of the required allograft skin necessitates establishment of more and more skin banks in various parts of India. “For a population of approximately 1.43 billion, the current number of skin banks (both public and otherwise) just don’t cut it,” Dr Singhal said while emphasizing the importance of promoting skin donation alongside organ donation and raising awareness through various media channels.

Across India, there are only a handful of other skin banks in a few other states. The first skin bank for deceased donors was founded in Mumbai in 2000. Then in 2009, an effective skin bank model was created through a partnership between the National Burns Centre Mumbai, Rotary International, and Euro Skin Bank which began operating in 2013.

The wide acceptance of this model led to the subsequent promotion of skin banks in Tamil Nadu, Karnataka, and Maharashtra. Other hospitals with operating skin banks include the Ganga Hospital in Coimbatore, the Government Stanley Hospital in Chennai, the Orange City Hospital in Nagpur, the Right Hospitals in Chennai, the Surya Sahyadri Hospital in Pune, the Victoria Hospital in Bangalore, a hospital in Cuttack, and the one in Bengaluru.

Allograft skin has the potential to play a major role in permanent skin reconstruction, requiring skin banks to increase cadaveric skin donation.

Saving lives

Skin donation banks play a vital role in providing life-saving treatment for burn victims and patients with severe skin injuries. The process of skin donation and transplantation offers a chance at recovery and improved quality of life for those who suffer from extensive skin damage. 

However, despite the increasing number of skin banks across India and successful collaboration between various organizations, there is still a significant gap between the demand for and supply of allograft skin. To address this issue, it is essential to raise awareness about skin donation, promote the establishment of more skin banks, and encourage collaboration between medical professionals, researchers, and the public.

Also Read: 5 Ways Stress Is Messing With Your Skin